Attention To Nose Bleeding In Hot Weather!

Epistaxis Risk Increases in Hot Seasons

nose bleeding, bleeding of the nose, nosebleed,The main causes of epistaxis,Nosebleeds can be seen due to the increase in temperature, changes in blood pressure and dilatation in nasal vessels in these days when the avalanches are warmer. Nasal bleeding (epistaxis), which is a common emergency department complaint, can often cause serious anxiety in patients. However, approximately 90% of the patients admitted to the emergency room with the complaint of epistaxis can be successfully treated by the emergency physician.

It has been reported that only 5-10% of nosebleeds require specialist medical intervention. Nosebleeds are divided into two as "anterior" bleeding from the front part of the nose and "posterior" bleeding from the back part.

Causes of Nose Bleeding

Local Causes


. Direct trauma to the nose (during an accident or fight)
. Digital trauma (finger trauma), especially in children, can be damaged and bleeding in the nasal mucosa during nasal mixing, which is a habitual practice.

nose bleeding, bleeding of the nose, nosebleed,The main causes of epistaxis,

In the adjacent photo, there is an image of the right nasal cavity of the patient who regularly tries to clean the inside of the nose with a napkin. The dry and crusted appearance of the mucosa located in the nasal septum and in the area in front of the nasal concha and the bleeding area in the lower-anterior part of the nasal seprum draw attention. The patient was recommended to use saline nasal wash and nasal moisturizers.

Surgical trauma

nose bleeding, bleeding of the nose, nosebleed,The main causes of epistaxis,

Bleeding may occur after complications (vascular incisions, septum perforation) that may occur after surgical interventions in the nose and sinuses.

Barotraumas (in flights and sea dives) can also cause bleeding from the sinuses and nasal cavity.

nose bleeding, bleeding of the nose, nosebleed,The main causes of epistaxis,

In the photo on the left, after nasal mixing, there is an intranasal endoscopic view of the patient with a small amount of nasal bleeding. It is seen that the mucosa on the convex ridge with cartilage curvature is irritated.

Anatomical deformities

. Nasal septal deviation and protrusions.

. Nasal septum perforations can often occur in people using surgery, digital trauma, tampons or cocaine.

nose bleeding, bleeding of the nose, nosebleed,The main causes of epistaxis,

In the adjacent photo, the photograph obtained during the endoscopic examination of the patient with nasal septum perforation and intranasal polyps is seen. Due to the hole in the nasal septum, there is a change in the intranasal air flow and the drying of the mucosa. In addition, cortisone medications and allergy medications given for nasal polyps treatment can also increase nasal dryness and nasal bleeding. The dry appearance of the nasal mucosa, bleeding areas on the polyp and behind the perforation draw attention.


. Infections can cause bleeding by causing edema, drying, drying, cracking and polyps in the mucosa and formation of fibrinolytic enzymes.

Foreign objects

. Foreign bodies in the nasal cavity can mostly be seen in children or people with mental retardation. Foreign body should be suspected in people with unilateral inflammation and bad-smelling runny nose.


A benign (benign) or malignant tumor in the nasal cavity.

Nose stones (rhinolith)

Having a vascular network (plexus) in the nasal septum in the area called Little (Kisselbach)

Locus Kiesselbachi / Kiesselbach's area / Little's area / Kiesselbach's triangle / Kiesselbach plexus

Some people have extra vascular anastomoses in the anterior part of the nasal septum. Especially in the presence of the above factors and in hot weather, bleeding can occur easily from the veins in this area.

Nosebleed - Epsitaxis

In the adjacent photo, a photograph of a patient with recurrent wedge of the nose, obtained from the endoscopic examination of the right nasal cavity is seen. Vasal and bleeding areas are seen on the nasal septum. Due to the patient's attempts to tamp with a napkin, areas of white irritation appear in some areas on the septum.

nose bleeding, bleeding of the nose, nosebleed,The main causes of epistaxis,

In the adjacent photo, there is an intranasal endoscopic view of a patient suffering from recurrent epistaxis in summer. The dense vascular area is visible on the right, anterior part of the nasal septum. Intranasal cauterization was planned for this patient every few months.

Systemic Causes

Hypertension and arteriosclerosis

hypertension and epistaxis

In the adjacent photo, there is an image obtained from the intranasal endoscopic examination of a patient with hypertension and epistaxis. It is seen that the nosebleed comes from the back and there is no bleeding area in the anterior region. Nosebleeds due to hypertension are mostly from the back and occur in the morning. Unlike other nosebleeds, bleeding can be more severe.

Presence of diseases and drugs that cause blood clotting disorder

. Disseminated Intravascular Coagulation
. Hemophilia A, Type B
. Osler-Weber-Rendu syndrome
. Glycosides - Coumarin Toxicity
. Toxicity of Nonsteroidal Anti-inflammatory Agents
. Rodenticide Toxicity
. Salicylate Toxicity
. Warfarin and Superwarfarin Toxicity
. Von Willebrand Disease
. Liver failure
. Leukemia
. Thrombocytopenia
. Heparin Toxicity
. Ticlopidine Toxicity
. Dipyridamole Toxicity

Other Causes

. Endometriosis
. Hereditary hemorrhagic telangiecasia (HHT)
. Excessive alcohol consumption
. Heavy metal poisoning
. Infections such as rheumatic fever, typhoid and scarlet fever
. Living in dry or polluted air
. Pregnancy (especially in the last 3 months, the effect of pregnancy hormones on the nasal mucosa reaches the highest level)

nose bleeding, bleeding of the nose, nosebleed,The main causes of epistaxis,

In the adjacent photo, the intranasal endoscopic examination photograph of a patient using medications for allergic rhinitis and a habit of nasal mixing is shown. Typical pale appearance of the nasal flesh in allergic rhinitis, dryness of the nasal mucosa and white areas due to irritation on the nasal septum are striking.

Nose Bleeding Treatment

nose bleeding, bleeding of the nose, nosebleed,The main causes of epistaxis,

Nosebleeds seen in young people and children are mostly in the form of pre-bleeding and can be treated with simple medical intervention and precautions; It is seen as posterior hemorrhages in elderly patients with arteriosclerosis and heart disease, and more interventions may be needed.

What Are The Precautions That Patients With Nose Bleeding Should Pay Attention To?

The dos and don'ts of patients who have frequent nosebleeds can be summarized as follows:

. It is necessary not to place any foreign body, napkin, cotton in the nose that may dry or irritate the nasal mucosa, and avoid mixing the nose

. It should be avoided to consume foods and liquids exposed to excessive heat and steam.

. Showering with very hot water should be avoided.

. You should go outside at noon when the temperature is the highest in the hot summer months and wear a hat if possible.

. Patients with high blood pressure should definitely consult their cardiologist.

. The use of non-steroidal anti-inflammatory drugs and blood thinners such as aspirin should be avoided unless recommended by the physician.

. In order not to be constipated and to increase mucous moisture, it will be beneficial to drink plenty of water in addition to eating pulp and juicy vegetables and fruits.

. The use of drugs such as allergy pills and allergy sprays that can cause dryness in the nasal mucosa should be avoided unless necessary.

. Drinks that can cause edema or dryness in the mucous membranes such as alcohol and coffee should be avoided.

What Should Be Done By The Patient When Nose Bleeding?

nose bleeding, bleeding of the nose, nosebleed,The main causes of epistaxis,
As soon as nosebleed is seen, the lower part of the nose should be squeezed into the index and thumb halfway, keeping the head higher than the heart distance and leaning forward. In this way, if the bleeding continues after waiting for 5-10 minutes, ice water and cooling gel can be applied to both cheeks, upper lip area and neck, right next to the nose. Ice cold water can be drawn in the nose and it can flow through the nose without blowing it. In case of nosebleeds during travel, nasal sprays can be sprayed into the nose at the time of bleeding, if cold application cannot be applied. In this way, the nose can be squeezed after applying cold application or nasal sprays, and if the nasal bleeding continues or increases gradually after 5-10 minutes, the nearest emergency clinic should be consulted. At the moment of bleeding, the head should be hung down to prevent bleeding from the respiratory tract and the bleeding from the back should be spit out and removed from the mouth. If the bleeding has stopped with these interventions, it will be useful to rest in an upright position with a pillow behind the head in a dark, quiet and cool room, if possible.

What Should Be Done By Physician In Nose Bleeding That Does Not Stop Despite The First Simple Precautions?

Especially in young patients, when recurrent bleeding from the vascular networks (LittleAlan or Kisselbach Plexus) is observed in the anterior region of the nasal septum, the vascular areas can be cauterized with the help of silver nitrate swabs after placing cotton impregnated with local anesthetic.

nose bleeding, bleeding of the nose, nosebleed,The main causes of epistaxis,
If the bleeding has not stopped despite all the aforementioned interventions (especially in the elderly, using aspirin or coumadin derivative drugs and patients with hypertension), further interventions are required. In patients who come to the emergency department, first of all, as emergency patients are approached, airway evaluation, filling system should be checked, vital signs are monitored and vascular access is established. In patients with high blood pressure, it should be tried to bring blood pressure levels to normal levels in consultation with a cardiologist. Although otolaryngologists stop the bleeding, it is important to eliminate the causes of bleeding.

Stopping bleeding by using tight nasal packs, especially in patients who use aspirin or coumadine derivative drugs and with hypertension, may cause intranasal mucosal tears and increase in bleeding frequency. For this reason, new modern soluble buffer materials can be preferred in these patient groups. Nose padding is done in the form of front and rear bumpers. If the bleeding has not stopped despite all these interventions, the bleeding can be evaluated endoscopically in the nose under operating room conditions, and the bleeding areas in the nose can be removed by cauterization. If it is observed that bleeding continues despite all these procedures, the vessels that supply blood inside the nose can be ligated after surgical incisions or help from radiologists for angiography and embolization can be requested.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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